Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.
UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK.
Palliat Med. 2021 Jun;35(6):1118-1125. doi: 10.1177/02692163211008737. Epub 2021 Apr 13.
Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed.
To explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial.
DESIGN/ PARTICIPANTS: Three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists ( = 28), caring for children with life-limiting illnesses receiving palliative care, participated.
Oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement.
There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.
口腔吗啡常用于缓解爆发性疼痛，但口服途径并非总是可行，且吸收缓慢。黏膜下二吗啡通过颊部、舌下或鼻腔给药，吸收迅速。
探索英国照顾生命有限儿童的医疗保健专业人员在评估和管理爆发性疼痛方面的观点；与口服吗啡相比，黏膜下二吗啡的处方和给药；以及进行比较临床试验的可行性。
设计/参与者：使用框架方法分析了三个焦点小组。参与研究的有 28 名医生、护士和药剂师，他们负责照顾接受姑息治疗的患有生命有限疾病的儿童。
在所有环境中，口腔吗啡都经常用于缓解爆发性疼痛；黏膜下二吗啡主要限于在临终关怀医院使用或由社区护士给予，主要是颊部。口服吗啡的优点包括对其使用的信心，无需特殊培训；缺点包括耐受性问题、起效缓慢、反应不可预测以及不适合胃肠道衰竭的患者。黏膜下二吗啡的优点包括起效快、易于给药；障碍包括缺乏许可制剂和处方指南，以及对处方者责任的担忧，以及可用性、准备和适口性方面的潜在问题。可能影响试验招募的因素包括患者的适用性和对家庭的负担、试验设计和后勤、工作人员时间和临床医生参与度。
黏膜下二吗啡有一定的优势，但需要获得安全的制剂。如果克服了障碍，进行临床试验是可行的。
